Healing With the Power of Placebo

March 12, 2016

Story at-a-glance

Trials show people often react to placebo in nearly the identical manner as an actual drug. Placebos have been shown to produce the release of a variety of brain chemicals, mimicking the effects of drugs

Placebo or sham surgery has been shown to produce results that are equal to actual surgery, even though the physical problem is in no way addressed

Placebos enhance athletic performance by about 3 percent, which can translate into taking gold in the Olympics versus failing to place in the top 10

By Dr. Mercola

"The Power of the Placebo" is a documentary film about exactly that: Placebos; how they work, and how you can harness their healing power. The fact is "dummy pills" do indeed work, and sometimes far better than anyone could have imagined.

For example, trials show people often react to a placebo in nearly the identical manner as an actual drug. Placebos have been shown to produce dopamine release and other chemical responses, mimicking the effects of drugs without actually taking an active ingredient.

By definition, a placebo is an inert substance that has no effect on your body. In medical research, placebos such as sugar pills are used as controls against which the effects of experimental drugs (also in the form of pills) are measured.

However, the placebo-effect, in which a patient believes he or she is getting an actual drug and subsequently improves despite receiving no active substance at all, has become a well-recognized phenomenon.

It also works with surgical procedures. Just like drugs, placebo or sham surgery has been shown to produce results that are equal to actual surgery, even though the physical problem is in no way addressed!

Interestingly, more recent investigations reveal the placebo effect is growing in potency among Americans, and it's having a dramatic impact on the development of new painkillers.

Drug companies are finding it increasingly difficult to get pain-reducing drugs through clinical trials, because as people's responses to placebos are getting stronger, it makes it more difficult to prove that the drug actually works.1,2

An unusual experiment featured in the film involved professional bicyclists. They were told they'd receive either a standard performance enhancing supplement containing caffeine, or a new supplement, expected to improve performance to a greater degree than the standard pill.

However, there was a twist. Both pills were placebo, containing nothing but corn flour. The racers were asked to cycle at max capacity twice in one day. The first race was to establish their baseline max, and the second to evaluate the effect of the supplement.

Interestingly, even though the racers were tired and received no active performance enhancer, half of them were faster in the second race.

The placebo even made one cyclist break his own personal speed record. After hundreds of similar experiments on athletes, these kinds of results are actually typical.

In general, placebos enhance athletic performance by about 3 percent, which can translate into taking gold in the Olympics versus failing to place in the top 10. So while 3 percent doesn't sound like much, it's a very substantial improvement in the world of professional sports.

Fake Surgery Works as Well as the Real Thing

Many are quick to conclude that the placebo effect is responsible for the benefits of alternative treatments and natural supplements — the implication being that the treatment doesn't really work, and any benefit is "all in your head."

Few stop to consider the fact that many of the benefits of conventional drugs and other interventions are also due to the placebo effect. And, unfortunately, drugs have the added downside of causing very real and adverse side effects.

One of the most dramatic examples of this was a now classic knee surgery study3 published in 2002. Not only does this double-blind, placebo-controlled, multi-center trial definitively prove the power of your mind in healing, it also reveals that most knee surgery for osteoarthritis is a waste of money.

The results of this study show that it's not the surgery itself that is responsible for the improvement; it's all due to the placebo effect. More precisely, it's the ability of your brain to produce healing when you believe it should be happening after receiving surgery.

As noted by the authors: "In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure."

Improvement Following Knee Surgery Is Due to Placebo Effect

Another study4 published in 2013 also found that arthroscopic knee surgery for degenerative meniscal tears had no more benefit than "sham surgery."

At the post-operative one-year mark, all patients, regardless of whether they had real or sham surgery, reported equal amounts of pain reduction, which led the researchers to conclude that real knee surgery offers no better outcome than sham surgery (placebo).

Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the US. According to this study, it's performed about 700,000 times a year to the tune of $4 billion.

But according to these findings, any claim that surgery is "the best" or "only" option for osteoarthritic knee pain is plainly false.

So, please do consider these kinds of findings when you're weighing your treatment options. Remembering that your mind is the real healer may help you find a safer and less costly alternative to going under the knife, which can have permanent adverse consequences.

Placebo Surgery Even Works on Fractured Spines

A similar sham surgery trial is presented in the featured film. Vertebroplasty is a procedure in which a fractured spine is repaired by injecting surgical cement into the bone. However, one doctor became aware of a strange anomaly.

Some patients, who for whatever reason received treatment on the wrong vertebrae, still received pain relief. So he decided to undertake a placebo trial. Some patients received the real procedure, and others received sham surgery.

Bonnie, one of the elderly patients in the study who had fractured her back during a fall, felt immediate pain relief following her sham surgery. As noted in the film, "the procedure transformed her life." With the pain significantly reduced, she became much more active. Within a week of the injection she was back to her daily golf game.

And yet nothing, except numbing the area and simulating the cement injection, had been done to her fractured spine. Interestingly, Bonnie had real vertebroplasty done before, putting her in the rare position of being able to compare the outcome of both procedures. In her words, "they were both so successful, I could go ahead and do whatever I wanted to do without any problem."

A total of 130 patients were included in this study. When the results were tallied, there was no statistical difference in the degree of pain relief between the real and the sham surgeries. Even more importantly, there was no statistical difference in the improvement of physical function between the two. More than 1 million Americans have received vertebroplasty over the past couple of decades, yet it is no better than placebo. Put another way, fake surgery works just as well.

Other Examples of the Medical Placebo Effect

Another excellent example of the placebo effect is that of antidepressants. Research5 published in 2010 suggests antidepressants work no better than a placebo for people with mild to moderate depression. An earlier meta-analysis6 concluded that the difference between antidepressants and placebo pills is very small — yet these drugs remain among the most prescribed drugs in the U.S. That hardly falls within the parameters of "science-based medicine."

Considering the long list of side effects associated with antidepressants, including worsening depression, it seems reasonable to conclude that a placebo would be a far preferable option to the real thing. Placebos have also been found to work as well as the migraine drug Maxalt (rizatriptan) for recurring migraines.7

Surprisingly, subjects reported pain relief even when they knew the pill they were receiving was a placebo, compared with no treatment at all. According to the authors, the placebo effect accounted for more than 50 percent of the therapeutic value of this drug.

As explained by co-author Ted Kaptchuk, director of the Program in Placebo Studies and Therapeutic Encounter at Harvard Medical School:8

"This study untangled and reassembled the clinical effects of placebo and medication in a unique manner. Very few, if any, experiments have compared the effectiveness of medication under different degrees of information in a naturally recurring disease.

Our discovery showing that subjects' reports of pain were nearly identical when they were told that an active drug was a placebo as when they were told that a placebo was an active drug demonstrates that the placebo effect is an unacknowledged partner for powerful medications."

How Does the Placebo Effect Work?

We now know the placebo effect is real. But what causes it? How does it work? Writing in the journal Neuropsychopharmacology9 in 2011, the researchers noted the following observations:

First, as the placebo effect is basically a psychosocial context effect, these data indicate that different social stimuli, such as words and rituals of the therapeutic act, may change the chemistry and circuitry of the patient's brain

Second, the mechanisms that are activated by placebos are the same as those activated by drugs, which suggests a cognitive/affective interference with drug action

Third, if prefrontal functioning is impaired, placebo responses are reduced or totally lacking, as occurs in dementia of the Alzheimer's type.

By using brain imaging technology during placebo tests, researchers have been able to show that even when a placebo is used, your brain still responds according to expectations. For example, in trials involving placebos for pain relief, the participant's brains release natural opioids that provide opioid-mediated pain control. So the placebo effect is tapping into the same pain control centers as opioid drugs.

Placebos can also trigger the release of many other natural brain chemicals, such as those involved in making us feel more energized, or those that help us sleep better. As noted in the film, "the placebo effect taps into our natural pharmacy."

Drugs work because we have the receptors for the drugs, and that means we have brain chemicals that act on those receptors. Receptors have evolved to react to those natural chemicals." In short, the placebo effect relies on chemicals — your own — which appear to be released in response to or in accordance with your mental or emotional expectations or beliefs.

So just how far can a placebo take you? Placebo trials on patients with Parkinson's disease have revealed that even this serious condition can be ameliorated with a "dummy pill."

Lack of dopamine is one of the factors producing the symptoms of Parkinson's, and brain scans show that when Parkinson's patients are told they're receiving an active medication, the dopamine levels in their brains increase — even when there's no active ingredient in the pill.

As noted in the film, a placebo can release as much dopamine as amphetamines in a person with a healthy dopamine system, so it's a dramatic response.

Mind Over Matter

Typically, for a placebo to work you have to believe it's a "real" drug. Why is that? Expectations, it turns out, play a crucial role in recovery from illness. There's a link between your mind and your body, and when you expect a pill (or surgery) to do something, your body yields to your expectation by producing the requisite brain chemicals. Needless to say, the stronger your belief or expectation, the more likely you are to experience the desired result.

This was demonstrated in a study10 in which people with back pain who believed that acupuncture would be helpful actually got more pain relief from it, compared to those who were skeptical about the treatment.

According to study author Felicity Bishop, Ph.D.: "People who started out with very low expectations of acupuncture, who thought it probably would not help them, were more likely to report less benefit as treatment went on." Factors that influence a person's expectations include the size, color and price of the medication, whether it's the real deal or a placebo. For example:

Capsules are more effective than tablets

Large capsules are more effective than small capsules

Expensive medications are more effective than cheap medications

Red pills are most effective for treating pain, while blue pills are most effective when treating anxiety — except if you're an Italian male. Bright blue is the color of the Italian soccer team, associated with "passion, excitement, and heartache," so for Italians, blue pills have the converse effect, according to the researchers in this film.

Interestingly enough, there's also evidence showing that the placebo effect can work even if you know you're receiving a placebo.

However, in these cases, the effects tend not to last as long. One woman suffering from irritable bowel syndrome was asked if she'd be willing to try a placebo. While highly skeptical, she agreed, and was astounded to discover she was no longer in pain after three days of taking the sugar pills. But as soon as she stopped taking the pills, the symptoms came back.

The study in question didn't try to decipher why the placebos worked, only whether they would work without deception, and in 63 percent of participants, they did provide relief despite the fact that the patients knew they were taking chemically inactive pills. One theory though, is that the mere act of seeing a physician and taking a pill twice a day somehow makes your body recognize that your intention is to get well.

How to Harness the Placebo Effect For Your Own Health and Wellbeing

The film also reviews the use of hypnosis — another treatment that has no "active influence" other than your own belief or expectation. In a way, hypnosis can be viewed as "a procedure that allows you to turn your own ability to produce a placebo effect." In the film, this is dramatically demonstrated by a man who opts for hypnosis over anesthetic when getting a wisdom tooth extracted.

At no point did he rate his pain over a four on a scale of 0 to 10. That's the power of placebo, and nothing but words were used to help him shift his expectations about what he was going to feel, allowing his brain to release natural painkillers.

Chances are, there will be occasions in your life where you can use your mind to help heal your body or reduce your reliance on conventional medical care, including medications. And when I say that, I mean that if you strongly believe you will benefit from something, you radically increase the chances that you will.

But there is one caveat: you may need to resolve any emotional blocks that are standing in your way first. Such a block could be the belief that the pain or illness cannot go away. Maybe a parent or relative had the same problem and they never recovered, so you probably "can't" get rid of it either. Another block could be resentment that you have the disease or the pain, or even an unconscious desire to keep your ailment because of the attention you gain from it.

The Emotional Freedom Techniques (EFT) is an extremely powerful tool for getting to the root of emotional conflicts such as these. By releasing them, it may be easier for you to open your mind and harness the power of the placebo effect. It's often possible to feel better just because your mind subconsciously believes it's time, or your subconscious alters body processes in response to the placebo treatment without you even being aware of it.

As often as possible, try to use the placebo option first. This is a new way of thinking about healing for most people, but can be extremely potent, especially when combined with a healthy outlook and disease-preventive lifestyle.

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